NM Insurers, Providers, Employers Push Ahead on Health Care Expansion

About a year ago, officials at the Santa Fe-based solar installation company Positive Energy Inc. took the first steps in getting the business’s 50 employees covered by health insurance.

Once the company offered the coverage, however, just 30 could afford the premiums, which start at $1,100 a month for a family that pays a $1,000 deductible, said CEO Regina Wheeler.

So with a Supreme Court ruling Thursday that will continue to expand access and coverage to nearly every American, Wheeler again has some work to do to make sure the other 20 employees will be covered.

“We’ll definitely ask Presbyterian to give us a new quote as the provisions go into place that would affect the premium,” Wheeler said.“The first thing I will do is call my insurance agent,” she said.

Wheeler, who applauded the decision, said she realizes how expensive the coverage is for employees. “It really is extraordinary,” she said.

The company’s employees are joined by millions across the country who work and are unable to afford coverage, a key aspect that proponents of the law aimed to fix.

With a ruling in place, the work of turning the Affordable Care Act into reality falls to many people in the health care system, from Medicaid providers to private health insurance companies and hospitals.

Among the places that will feel the impact of the high court decision are clinics run by companies that provide services under Medicaid. Under the act, millions of people are expected to be added to the program in coming years, although it remains to be seen how many, as states now must decide how much they want to expand their programs.

One of the companies providing Medicaid and already expanding in New Mexico is Molina Healthcare. The company opened a clinic in Santa Fe in February and has another one under construction in Albuquerque and another planned. It also has plans for one in Las Cruces.

Steve O’Dell, senior vice president at Molina Healthcare, said the company is prepared to be busy for the foreseeable future. With the upholding of the act, he said the company is looking at “hyper growth.” Already, the growth for the company and the number of people it serves is “substantial,” he said.

“With that additional volume of people coming in, there are going to be substantial access issues,” he said.

The numbers in New Mexico are huge: About a quarter of the population is uninsured, something state officials and health care activists have bemoaned for years.

The changes the law brings about are also substantial. Once the law is fully implemented in 2014, 182,000 people would qualify for Medicaid while 211,000 would be eligible for help buying health care, health care advocates say.

That means private insurance companies, too, must gear up for more people in the system.

CEO of Presbyterian Healthcare Services Jim Hinton said New Mexico care providers are going to have to be creative and innovative about how to serve the influx of new people in the coming years.

That means care could involve more technology such as telemedicine, or greater use of nurse advice lines, or workplace-based care. Other examples might be so-called retail-shop care, where patients can get a flu shot at Walgreens, for example, or patient-centered medical homes, where people have access to a primary care provider, and a pharmacist or radiologist all in one spot.

“I think we as a state need to continue to use that innovation to not try to drive this additional demand through traditional ways of taking care of people,” he said.

Presbyterian has 400,000 health plan members in the state.

Hinton said the law “could have the potential to pretty dramatically expand the market for insurance companies in the state, but it also will no doubt increase the pressure on the delivery system to provide care for patients in clinics and hospitals.”

As for Wheeler’s hope that insurance prices could one day go down as more people are covered, Hinton said that is a possibility, but won’t happen anytime soon.

At Lovelace Health Plan, CEO Ben Slocum said the ruling doesn’t mean many immediate changes because companies already have implemented provisions in the Affordable Care Act such as annual physicals, colonoscopies and mammograms, for which patients don’t pay out of pocket. Additionally, children up to the age of 26 can be covered under their parents’ plans.

Other provisions don’t take effect until 2014.

Lovelace, which has 240,000 members in its plan, will feel the impact as additional people sign up and are covered, Slocum said.

“I think everywhere in the country we are faced with challenge of people having the right number of health care professionals serving the community … I don’t think any of that concern goes away any time soon,” he said. That’s one of biggest challenges nationally and not just in New Mexico.”

At Christus St. Vincent Regional Medical Center, a spokesman said the hospital will redouble its efforts to work with doctors, staff and patients to continue to implement the law.“While reimbursement rates will continue to decrease as the health care law is implemented, it is our hope that we will see more and more people enroll in health plans to ensure they have access if and when they need it,” spokesman Arturo Delgado said in a statement.

Hospital associations across the country lauded the ruling, which is expected to help them financially as more patients gain access to insurance.

After the news was announced Thursday, local politicians weighed in on the political ramifications of the decision, with the Democrats supporting the decision and Republicans decrying it. At the same time, health care advocates and providers worked to put the decision into context.

“This is a historic decision that has the potential to benefit every single American man, woman and child by ensuring the rights of everyone to obtain affordable health care, regardless of health condition or employment status,” said Richard Mason of the Health Care for All Coalition in New Mexico.

“But this decision means the real work of extending health care to the hundreds of thousands of underserved New Mexicans — many struggling in jobs that offer no benefits — has just begun. Now is the opportunity for the Martinez administration and the Legislature to roll up their sleeves and get to work on full implementation of the Affordable Care Act, because it is a critical tool for covering New Mexicans and creating thousands of jobs in our state.”